Running with Back Pain

Do you suffer from back pain while running?

There are often alarming statistics quoted when it comes to Low Back Pain. One such statistic, produced by Datamonitor estimates that in 2010, that there were in the region of 55.7 million total prevalent cases of chronic low back pain reported in people aged 18 and over in the seven markets (the US, Japan, France, Germany, Italy, Spain, and the UK). It’s a real epidemic of modern living.

While active adults are thought to be less likely to suffer from chronic back pain than those in the sedentary population, us runners and triathletes are certainly not immune.

In fact, the repetitive nature of the movement patterns involved in endurance sports can greatly amplify the negative impact of soft tissue imbalances, movement dysfunctions or structural asymmetries leading to back pain. Just ask anybody who has suffered after a four hour bike ride on a poorly fitting bike!

The same can be said for running. Whether caused by a structural asymmetry, such as a leg length discrepancy, a movement dysfunction at the Sacroiliac Joint for example, or soft tissue imbalances around the hips and pelvis, running related low back pain can be both incredibly frustrating and debilitating when symptoms strike.

Causes of Back Pain in Runners

The possible underlying causes of low back pain in runners are greatly varied, too much so for this particular article. Instead, here are four of the common causes (far from an exhaustive list).

Four Common Causes of Low Back Pain In Runners

Poor Pelvic Posture and Dynamic Control

As we move cyclically through the various phases of running gait, both load bearing and non-load bearing, our legs move through a great range of motion at the hip joint in particular. In the sagittal plane we get hip flexion as the knee comes up in front of us, then hip extension as the knee and foot drives back behind the body.

Any restriction in the anterior hip musculature (Rectus Femoris tightness for example) will often lead to increased anterior pelvic tilt as the hip extends.

This will increase lumbar spine extension to keep the torso upright, adding undue stress to the low back region.

The Hips, Pelvis and Lumbar region comprise a a real cross-roads in the body. For the body to function properly, we need to achieve and maintain balance between the actions of the major muscle groups in this area. Thus enabling all muscles to fulfil their functional roles, producing both movement and stability where needed.

Weakness or inhibition of a particular muscle group often leads to tightness elsewhere (often in the back musculature) as a compensation. A great example of this is detailed in this post on Gluteal Inhibition and Weakness.

Reduced Thoracic Spine Mobility

Especially in the cases of many ‘office based athletes’ I meet who present with low back pain when running, I find that they frequently lack the ability to extend and rotate properly through their thoracic spine.

Picture the spine as a segmental unit, achieving motion in all planes as a net result of all the individual segmental motions. If a number of segments are limited in their motion (the thoracic spine in this example), then the overall spinal extension and rotation needed in running will come predominantly from the lumbar spine adding undue load to the local structures and soft tissues.

Increased Loading Through Poor Technique

All of the factors named above, and most of the many we haven’t covered, will all be exacerbated by running with poor form. It’s not only is it the increased impact while running with poor form, but also (and probably more importantly) the poor global posture and increased ranges of motion we see the pelvis move through that causes problems for the lower back. Try these six simple tips to improve running form.

What About Core Stability & Core Strength?

Firstly we need to define what is meant by Core Strength and Core Stability. There are many definitions out there for these generic terms, many of which speak of providing stability to the lumbar spine through strengthening the deep and superficial abdominal muscles.

Consider the fact that the bony and ligamentous architecture of the lumbar spinal segments give them a good level of inherent stability. If your back pain stems from having truly unstable spinal vertebrae, such as in the case of a lumbar spondylolisthesis, being able to run is probably the least of your problems.

What we should instead be considering in terms of Core Strength and Stability is this:

The ability to maintain good pelvic (and as a result lumbar spine) posture throughout the functional movements for our sport…

Strength, stability and mobility, all in the right areas will allow your ‘core’ to maintain a neutral pelvic posture. in addition, having good functional thoracic motion, is going to also be a factor in enabling you to be more effective in keeping the lumbar spine in a neutral position through the motion of running.

While typical ‘core’ activities such as floor-based Pilates will be great for getting a ‘feel’ for the activation of the correct core muscle groups, the real focus for a runner should be to train these muscles to provide pelvic control through functional ranges of motion in load bearing positions.

N.B. For a specific diagnosis and identification of root causes for your back pain symptoms, I strongly suggest a visit to a Sports Physiotherapist with a good knowledge of running biomechanics in particular.

Exercises For Running Related Back Pain

As with all exercises we share on this website, if it hurts, stop!

We previously said that there are many different types and causes of back pain in runners. Not all of the exercises below will be appropriate in every case. The videos below serve instead as an example of some back rehab exercises.

Please do seek the help of a Physio to get specific advice for your injury.

Low Back, Thoracic & Hip Mobility Exercises

Glute Activation & Pelvic Stability

Low Back Strengthening

James has an academic background in Sport Rehabilitation and a special interest in Applied Biomechanics. He currently coaches a large number of Runners and Triathletes across all levels of ability and performance. He's grown a strong reputation for enabling athletes to improve their running performance and overcome running injuries through improving their Running Technique and developing Running Specific Strength.

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13 Comments

I just like to add on to the pilates ‘floor’ based exercises. As a pilates trainer and a triathlete, pilates is more than the floor. It is a system of principles applied to any movement made whether that is supine, prone, side lying, standing, on the bike, swimming – pilates is in them all.

Don’t get me wrong, I’m not anti-Pilates at all. I was simply trying to illustrate to readers that there’s more to ‘core’ work than simple, floor based exercises. Although these do provide a great start-point for many. The sooner we can get an athlete up off the floor into a more run-specific exercise the better.

I’m on the slippery side of 50 yo and as an ex-farmer have fairly severe disc herniation and facet joint arthritis in the lumbar vertebrae. I run up to 60km a week without any back pain. In fact if I am careless and ‘put my back out’ I can often be be almost unable to put my shoes and socks on. The cure – go for a good run. It’s almost as if the muscles are in spasms and the run slowly but surely loosens them up. Works every time. Just thought you might find that interesting

You know what… I experience exactly the same thing. It was two bulging lumbar discs which eventually put an end to my rugby career. I still have ‘bad days’ with my back. For me it’s driving. If I spend too long seated in a poor position, I really struggle with sciatic symptoms. The two things that help me above all else:

1) Running – long and steady rather than speed work
2) Boxing – going 1min on : 1min off with a heavy punch bag

The latter I only found to be beneficial for me through trial and error. Not something I’d prescribe if giving professional advice.

My simply conclusion… my body likes movement. If symptoms get worse from being inactive with poor posture, then my remedy is to get moving!

An over-simplified view on this for sure. But it works in my case, and by the sounds of it, for you too

Thanks James for putting this up. Although it’s my fourth week of restricted training I now have a better understanding of why some of the exercises help. I’m now able to not only stand straight without any stiffness, but have gotten back on the bike – small sessions at that. Like you mentioned above, too much inactiveness and I feel like I’m an invalid.

I am now worried about doing any exercises that involves a lot of twisting. It’s still really easy for me to experience pain when simply attempting to turn around if I don’t think about my movement. However, I’ll maintain my personalised rehab training abut will have a look at some of the other body weight exercises that you have.

Hi James – do you have any articles relating to running and how it can potentially impact spinal alignment? It’s something which i know quite a few runners, myself included, struggle with from time to time.

Sorry if i’ve missed the article. I expect to some degree it’s tied to the above too.